FEMA-EC980901ELEVATION CERTIFICATE O.M.B. No. 3067-0077
FEDERAL EMERGENCY MANAGEMENT AGENCY Expires July 31, 1999
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to pro-
vide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to determine
the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR). You are not
required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form.
Instructions for completing thia form can be found on the following pages.
SECTION A PROPERTY INFORMATION
BUILDING OWNER'S NAME
STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
OITY
SECTION B
IFOR
INSURANCE COMPANY USE
POLICY NUMBER
COMPANY NAIC NUMBER
STATE
FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
ZIP CODE
Provide the following from the proper FIRM (See Instructions):
I I I j I Ioo / c) E q-- /~'~ ' ~f ~'~ C/~OO,,/''' (
In AO Zones, usedepth)
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): [i~] NGVD '29 ~ Other (describe on back)
8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
the community's BFE: L~_.~___I_._L~. L__t feet NGVD (or other FIRM datum-see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level ._J_.
2(a). FIRM Zones Al-A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of J I !~J~[J J.~feet NGVD (or other FIRM datum-see Section B, Item 7).
b). FIRM Zones V1-V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram, is at an elevation of [ J ~_~__~__J .U feet NGVD (or other FIRM datum-see Section B, Item 7).
c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is J J J.~ feet above [] or
below I J (check one) the highest grade adjacent to the building.
d). FIRM Zone AO. The floor used as the reference level from the selected diagram is J_~_J .U feet above [] or below [] (check
one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference
level) elevated in accordance with the community's floodplain management ordinance? [] Yes [] No [] Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations: .~NGVD '29 [] Other (describe
under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on
the FIRM [see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.)
4.Elevation mark used appears on FIRM: [] Yes ,~ No (See Instructions on Page 4)reference
5. The reference level elevation is based on: ~[,actual construction [] construction drawings
NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
case this certificate will only be valid for the building during the course of construction. A post-construction Elevation Certificate
will be required once construction is complete.)
6. The elevation of the lowest grade immediately adjacent to the building is:J J J (//J~_~. ~J feet NGVD (or other FIRM datum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest
floor" as defined by the ordinance is: k_l.. ~ J _J .I I feet NGVD (or other FIRM datum-see Section B, Item 7).
2. Date of the start of construction or substantial improvement
FEMA Form 81-31, MAR 97 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION